Precepting new nurses...

stidget99 · Jun 2, 2005

Any chance of talking to the powers that be and see if she can go back into orientation role for a bit longer? Either that, or make a transfer to a less stressful environment and then at some point down the road in her career, go back to the ER environment. Sounds like you've really taken to this gal and that she needs someone like you to support her.

Either way, good luck to the both of you.

**canoehead, BSN, RN** · Jun 2, 2005

A return to unofficial orientation would probably be helpful, can you be assigned the same shifts with her for a while. I have been in her shoes and it gets to the point that you question EVERY decision you make because you know someone will be following and checking you, and then telling everyone else how stupid you are.

If you have a more acute and a less acute side she would do well to stay less acute until she learns how to deal with the personalities on the unit. I really think that was half the battle when I switched to the ER. They are a much more blunt group than most, but then again a rock of support once you get them on your side.

mommatrauma, RN · Jun 2, 2005

Any chance of talking to the powers that be and see if she can go back into orientation role for a bit longer? Either that, or make a transfer to a less stressful environment and then at some point down the road in her career, go back to the ER environment. Sounds like you've really taken to this gal and that she needs someone like you to support her.
Either way, good luck to the both of you.

I have actually thought of that...It's part of my plan when I go and talk to them...giving them more than one option to choose from may actually give her a better shot at getting another chance...I have also discussed with her the possibility of needing to go somewhere else w/ a little less stress until she can get her bearings should the powers to be not buy into the second chance...Part of me thinks that might be the best for her right now...but there is another part of me that thinks she can do better and pull it off...w/some moral support...she doesn't get much of that from home, and alot of her friends are still in the college party mode..so maturity may also play a part here...I just don't want her to feel like she failed and give up all together...If she goes to another unit, it needs to be a decision she comes to on her own...its not my place to make that decision for her...I can only give her educated advice...She is very aware that the time is now, and that she really needs to start immediately at rescue and recovery as I like to call it...But at the same time, I did present to her the very real notion that she may not get another shot at this point, and it would be more fruitful for her to come to a decision about a transfer and bring it to the bosses herself, rather than waiting for the other shoe to drop and them make the decision for her...They are WAY more likely to try her again in 6 months if she goes to them first...but if she doesn't improve or waits to long...she won't be hired back...so it is definitely something she is weighing heavily right now...I told her when we meet we will talk about it further...The problem is she needs to realize her weaknesses and embrace them and learn from them....not trip all over them...and see them as failures...But its easier said than done...and you are right, I have taken to her...she reminds me alot of me when I was fresh out of nursing school...I had better support, but I still liked my partying, I was just turning 21....and it definitely effected my work ethic and how people treated me at work...I got the second chance, and realized it...and ran with it...and here I am....I guess this is what they mean about maturity and growing up and taking responsibility for your actions...someone cared enough about me to help...now I feel like I need to return that favor to someone else...Its a tough field...and the ER is a tough place to start out...but there is no reason why it has to be more stressful than it already is if someone can make the transition a little easier...I think maybe in the long run, she will be a better person because she had to work a little harder for it, and learned the value of doing your best, and how sometimes it can pay off....and just maybe someday she'll be here, posting the same concerns about her orientee...

mommatrauma, RN · Jun 2, 2005

A return to unofficial orientation would probably be helpful, can you be assigned the same shifts with her for a while. I have been in her shoes and it gets to the point that you question EVERY decision you make because you know someone will be following and checking you, and then telling everyone else how stupid you are.
If you have a more acute and a less acute side she would do well to stay less acute until she learns how to deal with the personalities on the unit. I really think that was half the battle when I switched to the ER. They are a much more blunt group than most, but then again a rock of support once you get them on your side.

Agree, and of the two coworkers I spoke with that had just had it with her they both said that they kinda felt bad that they sat back and let her falter not realizing that she was just really overwhelmed and didn't know how to come out and say it...Rome wasn't built in a day...now I only have to try and change about 50 or so other people's ill will feelings toward her situation...We do have a more acute side and a less acute side, and we have one that is kinda the middle ground, which is where she has been spending most of her time this week...so she gets to see both not sick and fairly sick patients...a pretty good variety...which I think is important still, because although she struggles now, one of the major hurdles she needs to overcome is prioritization and realizing what is sick and not sick...If she spends all of her time in the less acute side where everyone is pretty much the same acuity...its not helping her reach that hurdle and overcome it...

MAGIK GIRL · Jun 2, 2005

what kind of mistakes has she made? you mentioned that you thought that she was to far in the hole.....

i was in that situation 15 years again. i was told shape up or ship out to a less stressful department. well, here i am 15 years later.

if you think she will eventually make a good nurse, it would be ashame to lose her now. if she goes now and has the low self esteem you mentioned, she will probably give up and never come back.

i hope this works out for you and her. don't give up.

Aneroo, LPN · Jun 2, 2005

I wish I had something to add about the situation, but I am afraid I don't. However, will you be my preceptor? lol -Andrea

mommatrauma, RN · Jun 2, 2005

what kind of mistakes has she made? you mentioned that you thought that she was to far in the hole.....
i was in that situation 15 years again. i was told shape up or ship out to a less stressful department. well, here i am 15 years later.
if you think she will eventually make a good nurse, it would be ashame to lose her now. if she goes now and has the low self esteem you mentioned, she will probably give up and never come back.
i hope this works out for you and her. don't give up.

The mistakes she has made have been those such as really careless notes, ie pt was hypotensive and not another BP on chart for 2 hours...pt c/o dizziness...she said she did it but forgot to chart it...not charted not done...that's all I could give her back...She had a pt that needed antibx for urosepsis...they weren't hung for about 90 minutes after being ordered...for no good reason, pt had BC drawn and sent, ua/cult sent 2 IV lines, and nothing incompatible...most of her pt care issues are not major offenses in and of themselves, its that they add up in a short period of time...granted she did have other high acuity patients as well at the time...but she didn't recognize that it was time to ask for help...or even let the docs know...Our Docs are really good about the staff being jammed up with sick patients...if they are aware of the situation...but if you try for an hour to get in an NGT and don't get it...the docs should probably be aware of it a little sooner than over an hour later...The reason why I say she may be too far in the hole for me to help her is I'm aware that they are very closely watching her...and pretty much, just waiting for her to screw up...I don't know if there are other instances of problems, that I'm just not aware of...but the "we may have to let her go" phrase has been tossed around...I just don't know how much they are willing to give to let her try again...The most frustrating part to me is, the things she is messing up on are things that she had no real issues with during orientation...these are things she really should know better...There were a few other minor complaints from staff about her messing stuff up that "anyone with common sense" would know...some I agreed with, but there was definitely things that it wasn't necessarily true, and it is easy for us to sit back and say, where was common sense in all of this....but its biased..our common sense is based on 10 years nursing experience...hers is not...so what may seem really obvious to us, may not be so for her...My other issue is that one of the nurses said to me..."well she asks such stupid questions..." I almost lost my temper on that one...I much rather have her ask stupid questions and do the right thing then look stupid and do the wrong thing...but then it dawned on me...maybe this is why she doesn't ask...Is this the response she gets? Maybe she's just intimidated because she feels like she has no contact person. When our nurses get off orientation that have what is called a resource...which means that someone working in the orientees section is designated as the official question answerer and problem solver for them...So that they still have kinda a crutch to fall back on, but still work independently...Maybe the ball was dropped there and just kept getting kicked around until it popped...I do think she has potential, and there have been plenty of nurses I have crossed paths with that I can look at and just say...they aren't gonna make it...There are ER nurses, and nurses that work in the ER...there is a difference...I just had a better vibe about her...we'll see I guess...

MAGIK GIRL · Jun 2, 2005

oooo, you have your hands full! i agree with you about the response to her "stupid questions" bit. the only dumb question is the one not asked. the er can be an intimidating place itself. add a bunch of hard salty old nurses in the mix.....

i had one graduate nurse ask me how many cc's were in a teaspoon once.... i told her and then caught myself wondering if she should change careers. i thought twice about my thoughts and cut her breaks from then on. she ended up just not being cut out for the job. sad.

also, i have noticed that some nurses coming out of school are different than when i went to school. some of the ones i have seen seem to think they know all as soon as they walk thru the door. not all so please don't take offense if you are a new nurse reading this. i can only tell what i have experienced.

i also agree with the documentation issues and the hour long ngt. i wonder why she does not ask for help.

did you talk to her and tell her that her position is circling the drain? if so, what did she say?

bliss · Jun 3, 2005

[that someone working in the orientees section is designated as the official question answerer and problem solver for them...So that they still have kinda a crutch to fall back on, but still work independently...Maybe the ball was dropped there and just kept getting kicked around until it popped...I do think she has potential, and there have been plenty of nurses I have crossed paths with that I can look at and just say...they aren't gonna make it...There are ER nurses, and nurses that work in the ER...there is a difference...I just had a better vibe about her...we'll see I guess...

This is such a sad situation. It's just not easy, I think the first true injustice that was done to this nurse was to allow her into the ER in the first place.

Let me explain....When I started my career I was an LPN, my greatest wish was to work in the ER. I was told by the director that I needed experience before I could work in the department. I did my time (6 months) on a Progressive care unit. The day I hit the six month mark I called and begged to be allowed to come and work in the ER. She agreed and I started and never looked back. After many years, (approx. 10) I went back to school and became an RN.... once again I approached my director to please let me start working in the ER as an RN and was again told I needed the experience of being in charge and delegating. I was sent, again, to Progressive Care to work for at least 6 months before I returned. (All the other nurses thought it was insane to send me away, I had great evals, was told how good I did, knew my stuff etc, etc. Didn't work, had to go. I swear I cried every day, I hated working the floor, but my desire to go back to the ER was greater.

After 6 months I again went back to her and was allow to return. Thank God, I thought I would loose my mind working on the floor.

Bottom line, I hated my director for the longest time! BUT after a short peroid of time I relized that she was right. The other LPN's that knew me as a LPN now had to take direction by me as a RN, they were harder on me then any of the RN's. I passed all there test's, I proved myself. That was over 15 years ago. I believe that a new nurse, weather they have experience of any kind as a tech or as a LPN should work the floor before they work in the department espec. a level I trauma. Oh and by the way the ER I worked in was a level I trauma center in Orlando.

This nurse needs all the help she can get, the suggestion of going back to orientation is a good idea, if they allow new nurses to work in the ER, they should have 6 months of orientation. I use to tell all the nurses I trained that it takes a good year to feel comfortable and to get it.

I wish her the best, I understand the desire to work in an ER. I loved it.

Bliss

mommatrauma, RN · Jun 3, 2005

oooo, you have your hands full! i agree with you about the response to her "stupid questions" bit. the only dumb question is the one not asked. the er can be an intimidating place itself. add a bunch of hard salty old nurses in the mix.....
i had one graduate nurse ask me how many cc's were in a teaspoon once.... i told her and then caught myself wondering if she should change careers. i thought twice about my thoughts and cut her breaks from then on. she ended up just not being cut out for the job. sad.
also, i have noticed that some nurses coming out of school are different than when i went to school. some of the ones i have seen seem to think they know all as soon as they walk thru the door. not all so please don't take offense if you are a new nurse reading this. i can only tell what i have experienced.
i also agree with the documentation issues and the hour long ngt. i wonder why she does not ask for help.
did you talk to her and tell her that her position is circling the drain? if so, what did she say?

I did talk to her, not for ltoo ong because we were still at work...but she's stressed I can see it in her eyes, she looks exhausted...I did tell her that there has been discussion thrown around about the possibility that she may not have a job much longer if she keeps this up...She knows its bad...but at the same time, what I am trying to avoid is having her give up...Even if she isn't cut out to be an ER nurse, I don't want her to give it up altogether...she's worked too hard to get this far. I think alot of the reason she isn't asking for help is because she is feeling intimidated, she works 7p-7a and they are very strong night shift personalities to contend with...She oriented with me mostly 11a-11p with the exception of a few shifts I switched to 7p-7a so she could see what night shift flow is all about...I think if someone else besides me reached out to her and offered help she wouldn't feel like she had nowhere to turn...She in that sense, needs to be more assertive...because obviously some of the blame definitely falls on her as well for not at the very least coming to me sooner...someone she could trust...there are a handful of people that like her, and really want her to have a good chance, and mostly just feel bad for her...unfortunately, they do not work her shift...or at least not all 12 hours of it...I also think there is definitely a maturity issue...she's young fresh out of school...the carbon copy of me....10 years ago...but I can't make her grow up...I can only hope to help her mature at least in her patient care by helping her realize that this is her career at stake here....not just some job at the corner pizza place...and these are sick people and lives are at stake....I'm trying to come up with some kind of rough prioritization scale for her....not anything written in stone but just a guide to help her see what may be presented to her with her patients and how she may need to go about multitasking and what needs to get done first...I'm also going to have her make up a list of pro's and con's about this job and see where her head really is in all of this...and I hear you on the cc's and tsp question...there are days I work with some nurses, who have been there for years and ask silly questions...and I find myself going are you kidding me? and then I realize that not everyone learns the same, or retains information the same...and I'm sure I've asked a burning question or two that some other people thought I sounded like an idiot too...But like we both said, better to sound dumb and do it right then not ask and do something dumb...And you are right, there are some attitude issues with some of the new nurses that think they know everything...heck we have that problem with the seasoned ones too...and its a shame, because they isolate themselves because of it...this is definitely not the case here...If I could transplant 10cc of self esteem and 30cc of confidence...I'd donate some of mine...

mommatrauma, RN · Jun 3, 2005

[that someone working in the orientees section is designated as the official question answerer and problem solver for them...So that they still have kinda a crutch to fall back on, but still work independently...Maybe the ball was dropped there and just kept getting kicked around until it popped...I do think she has potential, and there have been plenty of nurses I have crossed paths with that I can look at and just say...they aren't gonna make it...There are ER nurses, and nurses that work in the ER...there is a difference...I just had a better vibe about her...we'll see I guess...

This is such a sad situation. It's just not easy, I think the first true injustice that was done to this nurse was to allow her into the ER in the first place.

Let me explain....When I started my career I was an LPN, my greatest wish was to work in the ER. I was told by the director that I needed experience before I could work in the department. I did my time (6 months) on a Progressive care unit. The day I hit the six month mark I called and begged to be allowed to come and work in the ER. She agreed and I started and never looked back. After many years, (approx. 10) I went back to school and became an RN.... once again I approached my director to please let me start working in the ER as an RN and was again told I needed the experience of being in charge and delegating. I was sent, again, to Progressive Care to work for at least 6 months before I returned. (All the other nurses thought it was insane to send me away, I had great evals, was told how good I did, knew my stuff etc, etc. Didn't work, had to go. I swear I cried every day, I hated working the floor, but my desire to go back to the ER was greater.

After 6 months I again went back to her and was allow to return. Thank God, I thought I would loose my mind working on the floor.

Bottom line, I hated my director for the longest time! BUT after a short peroid of time I relized that she was right. The other LPN's that knew me as a LPN now had to take direction by me as a RN, they were harder on me then any of the RN's. I passed all there test's, I proved myself. That was over 15 years ago. I believe that a new nurse, weather they have experience of any kind as a tech or as a LPN should work the floor before they work in the department espec. a level I trauma. Oh and by the way the ER I worked in was a level I trauma center in Orlando.

This nurse needs all the help she can get, the suggestion of going back to orientation is a good idea, if they allow new nurses to work in the ER, they should have 6 months of orientation. I use to tell all the nurses I trained that it takes a good year to feel comfortable and to get it.

I wish her the best, I understand the desire to work in an ER. I loved it.

Bliss

I go both ways on this...I personally started out in med-surg/oncology/telemetry/ICU cumulative 4 years prior to going to the ER...It was the best experience I ever had..I definitely learned how to prioritize, time manage, learn sick/not sick...get a comfort zone...and build confidence...now, onto your comment...we actually had a lot of brand new nurses start just around the same time she did...2 have since left but not counting her, there are 4 others that are still with us, and absolutely thriving and doing very well, my previous orientee included...some even better than our nurses who have been here for 10 years....I think every case is individual...and has to be treated as such...not everyone is cut for the ER, just like I'm not cut for Labor and Delivery...some learn faster than others...some never learn at all...but not every nurse needs to go to a floor to learn these skills...some it just comes naturally to...others have to work at it...and others have to work really hard at it...and proving yourself...is a big thing...there is definitely a right of passage...and the respect is earned not given...but their comes a point when you have to put all of that aside and do what is best for the patient...and if the patient is suffering because there is a personality conflict between two staff members...something has to change...one of our new nurses that didn't cut it had some very "I want to be everyone's friend issues" It seemed like she was there more for the social event of it and not for the patient care....yes I may take 3 minutes in the hall and talk about my weekend...but you can be darn sure I'm caught up and not delaying patient care over it, as a new nurse she had more down time then I ever did, and as a matter of fact I remember my first day ever in the ER and I didn't sit for 12 hours and 22 minutes straight...she needed a little more huggy lovey kinda staff, that had time to discuss their pedicures and weekend parties...and like I said in the past, we are ER nurses, not a huggy lovey group by nature...get your work done...and when thats all squared away, then you can worry about being friends...Maybe my orientee needs to go to the floor and learn how to be able to better manage...I have brought it up with her at our initial meeting about possibly a temporary transfer...but like I also said before, she needs to realize it for herself that she has a weakness...I can only make suggestions and hope she trusts me enough to listen to my advice...maybe 2 more weeks orientation would be helpful...I don't know at this point...I'm just not sure what she needs most right now to help make this (nursing in general) work for her. I am planning on having a meeting with management tomorrow maybe that will shed more light on the situation...